How far should the government go to protect us from peril? And what happens when the interests of public health collide with religious beliefs and personal conscience? At the turn of the 20th century, a smallpox pandemic swept the United States and its overseas territories. The government responded to the epidemic by calling for compulsory vaccination, enforced by quarantines, pesthouses, and "virus squads"—corps of doctors and club-wielding police—which ultimately contained the disease but also sparked a popular resistance among Americans who perceived them as a threat to their health and to their rights. Michael Willrich offers a gripping chronicle of how the nation's fight against smallpox launched one of the key civil liberties struggles of the 20th century.

"Today's controversies over vaccinations pale beside the pitched battles fought at the turn of the 20th century, to judge by this probing work. Historian Willrich revisits the smallpox epidemic that ravaged the United States from 1898 to 1904 and sparked a showdown between the burgeoning Progressive-era regulatory regime and Americans fearful of the new Leviathan state and the specter of 'state medicine.' Anxious to stamp out the contagion, public health officials in the South quarantined African-Americans in detention camps if they were suspected of carrying the disease and vaccinated others at gunpoint; in New York 'paramilitary vaccination squads' raided immigrant tenements, forcibly inoculating residents and dragging infected children off to pesthouses; their coercive methods sparked occasional riots and lawsuits that helped remake constitutional law. Willrich sees merit on both sides: draconian public health measures saved thousands of lives, but resisters did have legitimate concerns about vaccine safety and side effects, racial targeting and bodily integrity.... His lucid, well-written, empathetic study of a fascinating episode shows why the vaccine issue still pricks the American conscience."—Publishers Weekly